Minutes of Criminal Justice and Health Homes Committee
April 28, 2015
Attendees
Governor’s Office, Commission of Corrections, OMH, DOCCS, DOH-OHIP, OPCA, DCJS,
NYC Mayor’s Office of Criminal Justice, NYC DOHMH
Brooklyn Health Home CUCS, Huther Doyle, Montefiore Medical Center, Bronx
Lebanon, CBC Health Home
EAC-TASC, Correctional Association, John Jay College, CASES, CSH, LAC
Medicaid Enrollment/Suspension/Reinstatement
The meeting began with an update by David Bacheldor from the New York State
Department of Health, regarding what New York State is doing around enrollment
and suspension of Medicaid status regarding individuals incarcerated in New York
State and local correctional facilities. Mr. Bacheldor went through the PowerPoint
presentation he had prepared, which covered:
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Clinton County pilot taking subset of applications for those in DOCCS custody
(those who were non-MAGI and did not live in NYC prior to their
incarceration) starting September 2013.
NYC HRA is responsible for the non-MAGI population under DOCCS custody
returning to NYC.
OMH discharge planners – Until Certified Application Counselors can support
all State Correctional Facilities, continuing to work through Clinton County
for those who are not from NYC and through HRA for NYC. OMH staff are
assisting both MAGI and non-MAGI
Transitioned DOCCS applications to the New York State of Health (exchange)
in October 2014 for MAGI population
There have been some problems with suspension and reinstatement through
the Exchange
o Certain individuals were not appearing on the suspension file SDOH
sends to DOCCS
o Releasees not having coverage reinstated thru WMS
o DOCCS sending info but Exchange not processing properly
o DOH is working on a fix to reinstatement through the exchange.
Process should go live on May 7; interim solution in place until fix.
Local jails outside NYC
o Problems around jails not providing certain info to DCJS, regarding
both pre-trial and sentenced population
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There is no requirement for local jails to report client specific
information to the DCJS; admission information is historically
incomplete;
DCJS provides DOH with a monthly file of those it knows have
been admitted to local jail after they have been in for 30 days.
However, DCJS does not receive a discharge file from jails re:
above. One issue is that each jail has a different management
system.
DCJS is working on a process to accept files of who has been
admitted.
Having conversations with DCJS, sheriff’s association to fix
discharge process. Not significant process
Part of the problem is that individuals can be released from a
number of different locations, not just from the jail (e.g. from
court)
Certified Application Counsellors (CACs) processing MAGI apps
in some local jails thru the exchange. CACs must then assist
those who are enrolled with having Medicaid reinstated after
release
Non-MAGI must apply through their local social service
district, using the WMS system
Rikers
o Provides both admission and release files to WMS.
o Info not currently being sent to exchange because process not
working
o Conversations taking place with NYC HRA about processing
applications for those on Rikers until exchange process works (for
both MAGI and non-MAGI)
o State DOH is partnering with CUCS to pilot taking applications
through the exchange
 Starting with small number of individuals – all individuals who
are sentenced to jail term, are part of the MAGI population, are
incarcerated in either the EMTC or Rose Singer facilities, and
are not part of the Brad H lawsuit population
Suspension
o Individuals must have their Medicaid suspended because State does
not want to pay managed care premiums for those who are
incarcerated; however, because many people get out very quickly,
suspension only occurs after the individual has been in for 30 days.
o Individuals have coverage reduced to limited package of services
when in suspension, essentially coverage for services provided
outside of the jail system.
o Looking for match with those who have active Medicaid
o Potential savings to county of having a person’s Medicaid active upon
release.
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Medicaid cards
o Those enrolled while incarcerated (or those who enter with a card)
are released with a card.
o Only begun getting cards recently – very few at present.
o Making changes to WMS to allow for cards to be sent
o Initially upon release, individuals have inpatient coverage only.
o The release file is sent to DOH the next day. Use batching to change
coverage overnight.
o Individuals do not need cards to begin receiving services
o Discussion about providing new cards for people who were “known to
system” before their incarceration
 State DOH unsure how to handle
 As a result, most people do not have cards
 Gap analysis being carried out by team working on issue
During the meeting, it was decided that the workgroup should establish a sub-group
to work on the jail issue. Meg Egan from the Governor’s Office agreed to create a list
of members.
Leadership structure
Following the discussion about Medicaid, Greg Allen of DOH raised the issue of the
workgroup’s leadership structure. He pointed out that the group had gotten
significantly bigger, the conversation were much more detailed, more work was
taking place now at the local level, including efforts to enroll and connect people
through the courts and through ATIs.
Greg proposed having the health homes and the criminal justice groups run the
meetings. He explained that this would not involve the state backing away from the
work. Instead, he felt that such a structure would enable those providing the
services to own the work. He called on participants to nominate themselves as cochairs by emailing him and Paul Samuels of LAC (the other current co-chair). The
two of them would then select among the nominees. They would then develop a
process for figuring out governance of the group.
Trish Marsik of the New York City Mayor’s Office of Criminal Justice expressed
concern that this would result in a loss of leadership and commitment by State DOH.
Greg insisted that the State would remain focused, with continued involvement (and
more engagement) by Lyn Hohmann and Deirdre Astin from DOH and Meg Egan and
Tracie Gardner from the Governor’s Office. Trish suggested that the group revisit the
situation in the future, a suggestion that both Paul and Greg agreed to do after a
couple of meetings.
Budget
Greg also gave an update on the State budget. He explained that the State had
included $5 million in the budget to support the workgroup’s efforts. He explained
that the budget provided significant breadth in how the money could be used. Greg
explained that the budget also included $1M to enroll “high risk” individuals, in
particular those with substance use disorder and mental illness, onto Medicaid. He
explained that this was particularly needed for people to access services from places
such as pharmacies. He said that this money would be largely focused on jails, in
order to encourage their capability to enroll people.
Updates
Deirdre Astin then went through a PowerPoint developed by DOH. She explained
that the initiative had begun with the HH-CJ Pilots (which she described as early
adopters), as well as Project Partnership HH, CBC. She said that DOH wanted to have
a follow-up survey with the pilots to get an update on their activities. She also
explained that DOH had a student working with them who would conduct a followup survey, based on the template used in prior surveys.
Deirdre also described certain themes from the pilots, including:
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Numerous efforts to work with Rikers
Initiatives to work with parole
Working with drug and mental health court
Having a county sheriff and a local DA on one health home’s board
The leveraging of existing relationships
Another issue that Deirdre raised was data sharing, which she described as critically
important. However, she explained that obstacles existed as a result of Medicaid
privacy laws. She explained that DOH is having conversations with the federal
Centers for Medicare and Medicaid Services regarding getting the ability to share
date with parole and probation.
Deirdre also discussed the issue of metrics, explaining that DOH was doing work
with DCJS to examine what could be done.
Deirdre ended her presentation by discussing New York’s Medicaid waiver. She
explained that most of the money was going to the State’s DSRIP initiative which
was working to improve safety net systems. which should result in benefits for the
criminal justice population, who are frequently recipients of safety net services. She
also explained that each of the DSRIP PPSs had been required to perform a
community survey to determine what needs existed and that one area that was
proposed as part of the survey was criminal justice. Deirdre explained that the
waiver also included $190.6M for Health Homes to help with four areas. The first
part of this money had gone to the health homes in March as a rate add-on. One of
the areas included linkages to serve specific populations. DOH included the criminal
justice population as a target population in this effort.
Pilot Updates
Brooklyn Health Home
Hannah Loeffert of the Brooklyn Health Home (BHH) provided a PowerPoint
presentation on the work being done by BHH to serve the criminal justice
population. She said that BHH had been working closely with Pat Brown of the New
York City DOHMH. She explained that the work was targeting the mental health
population and included efforts to secure long-term linkages.
Hannah explained that BHH has a liaison appointed to DOHMH. The liaison sends
BHH’s census to the City to help find people who are in the health home who are
incarcerated on Rikers. BHH has developed a critical event notification system,
which provides care managers with such data as: admission to Rikers, upcoming
court dates, eligibility for Brad H. services, projected and actual discharge dates.
For all Brad H. clients, social workers on Rikers are notified of the individual’s
affiliation to BHH and efforts are made to connect the social worker with the care
manager. If the individual is not assigned to another health home, BHH workers will
try to connect the individual to services at BHH.
BHH has had issues around getting individual’s Medicaid changed from “inpatient
only” status to full Medicaid. When the system works well, the process takes
between 48 and 72 hours.
The process is currently funded through grants and Maimonides is looking for
mechanisms to make the project sustainable once the grant ends. Hannah explained
some smaller agencies are unable to participate but the bigger ones are sometimes
willing to accept the financial cost.
Lastly, Hannah explained that BHH has regular monthly meetings of the providers in
its network and that it is working to try to expand its network. It is also looking to
develop guidance about best practices.
Later, in response to a question about how many people were receiving services at
Rikers, Hannah mentioned that BHH was finding 10% of its census population going
through Rikers.
Bronx-Lebanon
Virgilina Gonzalez spoke briefly about the work being done by the Bronx-Lebanon
Health Home to work with individuals being released from Rikers. She spoke about
Bronx-Lebanon’s strong history of working with Rikers and of the relationship that
the facility has with Alison Jordan of DOHMH
Virgilina described the pilot as a real challenge and mentioned the need for housing
and the transition process as particularly important areas, emphasizing the need for
a “warm handoff.”
She explained the need for care coordinators to go to Rikers to speak with
individuals prior to their release and to be there and meet them on day of release.
Virgilina said that Bronx-Lebanon has been working with the Fortune Society
around getting assistance with care coordination around the transition back to the
community. She explained that Fortune was providing clients with education, care
coordination and initial help with finding housing.
Lastly, Virgilina discussed the weekly conferences that Bronx-Lebanon staff have
with Alison Jordan and her team to share information.
NYC DOHMH
Alison Jordan provided an overview of some of the efforts being made by DOHMH
staff on Rikers Island. She explained that DOHMH is looking to expand its discharge
planning efforts on Rikers but that DOHMH is not at a point where it can provide
services to all health health members. She explained that DOHMH was receiving
grant funding from Bronx-Lebanon to support a project coordinator and frontline
discharge planning. Alison also explained that DOHMH was looking to assess the
outcomes of the interventions it has been offering.
Michelle Martelle from DOHMH also spoke briefly. She explained that DOHMH is
now doing roster sharing with seven of the health homes in New York City. She said
that 4 - 9% of the health homes’ rosters have histories of incarceration in New York
City. Furthermore, 1300 of the 10,500 individuals on Rikers on any day were
affiliated with one of the seven health homes.
DOCCS
Doctor Carl Koenigsmann explained that DOCCS was in the very early stages of
exploring how to link individuals being released from DOCCS to health homes. He
explained that DOCCS had created a video for those who are in phase three of the
release process to introduce them to the concept of health homes. He said that
DOCCS was still waiting for a brochure from DOH to be able to roll the video out.
Dr. Koenigsmann also explained that DOCCS did not have significant infrastructure
in place around the discharge planning process for linking individuals to health
home services, though they do have services for placing the sickest patients into
nursing homes. However, DOCCS is in the process of creating a discharge planning
unit that would be primarily responsible for interacting with health homes on the
outside. He said that DOCCS is currently looking to promote or hire into the needed
positions in the unit. The unit would be responsible for identifying health home
candidates and helping them to transition into the community.
Lastly, Dr. Koenigsmann described a pilot of 5 health home eligible individuals being
released from DOCCS. He said that DOCCS had gotten a health home to come into the
facility and meet with clients. Dr. Koenigsmann said that the process had worked
very well, there was good flow and four of the five individuals were engaged by
health homes (the fifth person violated his parole).
Ana Enright from the community supervision section of DOCCS explained that she
wanted some health homes to come present at parole offices about health homes in
order to help train the officers, in order to help them be able to identify those
eligible for health home services, though one of the health homes explained that
DOCCS should start referring individuals and allow the health home to determine
whether the individual is eligible for services.
DCJS/OMH JUSTICE MENTAL HEALTH COLLABORATION PROGRAM
The meeting ended with a presentation from Bernard Wilson and Valerie Chakedis
from the Office of Probation and Correctional Alternatives (OPCA) regarding a
webinar that OPCA is planning to present on June 22, which would include
discussion of health homes.
They explained that OPCA had performed sequential intercept mapping of
individuals of opportunities and services in 10 counties, which represent half the
population (under supervision) outside New York City. There is also significant
overlap between these counties and the 16 county reentry taskforces outside New
York City.
They explained that the project was part of a federal Bureau of Justice Assistance
grant to support collaboration between the criminal justice and mental health
systems. The grant works to encourage community care coordination technical
assistance.
OPCA’s webinar is taking place on June 22, from 2 to 3:30. All 10 counties that are
participating in the collaboration program, including their coordinating committees,
were being invited to participate in the webinar, along with the other 47 probation
departments outside of New York City and the 16 county reentry taskforces.
(Valerie explained that OPCA was focusing on upstate in part because of the health
home implementation schedule.)
They explained that OPCA would provide an update about timelines around the
transition to manage care. OPCA had invited Kelly Hansen from the New York State
Conference of Local Mental Hygiene Directors and Bob Lebman of Huther Doyle to
present and was also looking to possibly have Hannah Loeffert present on lessons
learned at the Brooklyn Health Homes. She said that she and Bernard had also spoke
OPCA is hoping to also have an update regarding information sharing from the
county implementation teams and/or the county reentry taskforces, regarding
efforts to link with health homes.